Introduction

Intervertebral disc disease (IVDD) is commonly seen in dogs in veterinary practice. The clinical signs of IVDD are back or neck pain, trouble walking, lameness, trouble urinating, paresis and/or paralysis. The most common types of thoracolumbar IVDD are caused by herniation of the nucleus pulposus into the spinal canal (Hansen’s Type I), and protrusion of the intervertebral disc into the spinal canal, with the dorsal annulus still coving the disc material (Hansen’s Type II). Acupuncture and rehabilitation can be effective at returning dogs to an ambulatory state, and return of normal function, when used alone or in combination with Western medicine and surgery, for both types of IVDD. Several studies have shown promising effects of using electroacupuncture at treating IVDD in dogs and rat models. This presentation explains the Traditional Chinese Veterinary Medicine (TCVM) etiology and effective treatment modalities, which include physical rehabilitation used in IVDD cases.

TCVM Etiology and Pathophysiology in IVDD

The nervous system is related to the Kidney (bones and spinal cord), the Liver (joints and smooth flow of Qi and blood), and the Spleen (muscle strength). IVDD are often also considered as a Bi syndrome and are usually accompanied by a Wei (weakness) syndrome. There are 2 Excess Patterns and 3 Deficiency Patterns that are associated with various forms of IVDD. The Excess conditions are invasion of WindColdDamp and QiBlood stagnation, which are often associated with acute trauma in chondrodystrophic dogs (Type I). The Deficiency Patterns, often associated with chronic, Type II IVDD in nonchondrodystrophic breeds, include Qi/Yang Deficiency, Yin Deficiency and combined YinQi Deficiency (Table 1).¹

Table 1. TCVM treatment of the most common patterns of IVDD

TCVM Treatment for IVDD

1.  Acupuncture: Acupuncture has been proven to be an effective therapy for IVDD.^2-8
A general acupuncture treatment plan for a patient with IVDD is as follows:

a.  Dry needle: GV-20, Liu-feng, BL-60, KID-3, SP-10, LIV-3, BL-40, ST-41, GV-1

b.  Electroacupuncture: (20–40 Hz for 10 minutes, 80–120 Hz for 10 minutes, 200 Hz for 10 minutes) at the following pairs of acupoints:

i.  GV-14 to Bai-hui or GV-1

ii.  Left BL-11 to right Shen-shu

iii.  Right BL-11 to left Shen-shu

iv.  Hua-tuo-jia-ji at/or proximal and distal to the suspected or diagnosed disc space, bilateral

v.  ST-36 to GB-34, or ST-36/GB-34 bilateral

vi.  KID-1 to BL point proximal to IVDD lesion, or KID-1/Liu-feng, bilateral

c.  Aqua-acupuncture (vitamin B12) at Hua-tuo-jia-ji at/or proximal and distal to the suspected or diagnosed disc space, KID-1, BL-40, LIV-3, LI-4, Liu-feng

d.  Hemoacupuncture: use acupuncture needle or 24G hypodermic needle to puncture Jing-well points on the affected limbs and Wei-jian acupoint and get a few drops of blood.

2.  Scalp acupuncture:

a.  Motor area: A line starts at GV-22 and extends cranial and ventral to TH-23 on the lateral eyebrow

i.  GV-22: In the small triangular area formed by the ridges of the frontal crest

ii.  TH-23: In the depression on the rim of the orbit at the end of the eyebrow where it extended to the lateral canthus

b.  Sensory area: Starts at GV 20 and extends cranial and ventral to Nao-shu

i.  GV-20: On dorsal midline on a line drawn from the tips of the ears level with the ear canals

ii.  Nao-shu: Over the temporalis muscles ⅓ the way along a line from the cranial ear base to the lateral canthus

c.  Long insertion methods: use 32–38G acupuncture needle (½” for small dogs and cats; 1” for big dogs) to penetrate subcutaneously the entire motor line (from GV-22 through TH-23) and sensory line (from GV-20 through Nao-shu). Rotate, lift and thrust, or EA the needles every 2–3 minutes.

3.  Herbal medicine: General herbal dosage for dogs is 0.5 g per 10–20 lb body weight BID for 2 to 4 months, and then as needed (Table 1).

a.  Da Huo Luo Dan or Double P II (Da Hua Luo Dan modification) is the primary herbal medicine used to treat IVDD. It may cause loose stool in some cases. It can be used as long as the gut is able to tolerate it. Do not give if patient is sensitive to herbal medications or is prone to diarrhea.

b.  Add Bu Yang Huan Wu for Qi or Yang Deficiency (rear weakness, pale and wet tongue, and deep/weak pulse). Better tolerated than Double P II, so can use instead of Double P II if animal is prone to diarrhea.

c.  Add Di Gu Pi San for Yin Deficiency (cool-seeking, rear weakness, red/dry tongue, fast/thin pulse).

d.  Add Hindquarter Formula for Qi and Yin Deficiency (cool-seeking, rear weakness, red or pale tongue, and fast/weak pulse).

e.  Add Stasis Breaker if a tumor or mass is present in the spinal cord.

f.  Add Jie Gu San for fractures of the vertebra.

Acupuncture Researches in Neurological Conditions

Analgesic Effects

• After EA at GB-30 and BL-40 for 25 minutes daily for 7 days, rabbit with injured sciatic nerve had significant higher densities of normal myelinated fibers and more small myelinated fibers as compared to those in the diclofenac and control groups. Their results revealed and confirmed that EA promotes nerve regeneration while diclofenac does not have such an effect.¹²

Spinal Nerve Injury

• EA combined with standard Western medical treatment (group 1) was effective and resulted in shorter time to recover ambulation and deep pain perception than Western treatment alone (group 2) in dogs with signs of thoracolumbar IVDD. Overall success rate (all dysfunction grades) for group 1 (23/26; 88.5%) was significantly higher than for group 2 (14/24; 58.3%).³
• The proportion of dogs with clinical success was significantly higher for dogs that underwent EAP (15/19 dogs, 79%) than decompressive surgery (DSX) (4/10 dogs, 40%); the proportion of dogs with clinical success for dogs that underwent DSX + EAP was intermediate (8/11 dogs, 73%). EAP was more effective than DSX for recovery of ambulation and improvement in neurologic deficits in dogs with long-standing severe deficits attributable to IVDD.²
• Acupuncture at GV26 and GB34 significantly alleviated apoptotic cell death of neurons and oligodendrocytes, thereby leading to improved functional recovery after spinal cord injury (SCI) in rats. Acupuncture also reduced the size of lesion cavity and extent of loss of axons. It also significantly reduced proinflammatory factors after SCI.¹³

Brain Injury

• Acupuncture can improve neuranagenesis by promoting the proliferation and differentiation of neural stem cells in brain tissues.¹⁴
• Electroacupuncture (EA) at ST-36 acupoint improves neurological recovery in rats with intracerebral hemorrhage. EA exerts neuroprotective effects on hemorrhagic stroke by upregulation of Ang-1 and Ang-2.¹⁵

Outcome Measurement

Using a 0–5 grading scale to evaluate clinical neurological signs of IVDD (Table 2), it can be a valuable tool to help choose the mode of treatment, determine the prognosis, and assess the success of treatment.⁹ For the most optimum recovery, it is best to use TCVM with decompressive surgery for cases with grades 4 and 5. IVDD with grades 1 to 3 may be successfully treated with TCVM alone.^2-8

Table 2. Neurological grading scale in canine intervertebral disc disease

A 2010 study evaluated the effectiveness of acupuncture in comparison to decompressive surgery, and a combination of both surgery and acupuncture, in forty dogs that had long-standing clinical signs of IVDD (>48 hours). The dogs were re-graded six months after onset of clinical signs, and were considered a success if they returned to ambulation (i.e., they decreased from grades 4/5 to grades 1/2). This research demonstrated that electroacupuncture had a greater success (79% or 15/19 dogs) than did decompressive surgery alone (40% or 4/10 dogs). Dogs that had both decompressive surgery and electroacupuncture had an intermediate response (72% or 8/11).² This study indicates that the duration of clinical signs prior to treatment appears be an important factor in determining if decompressive surgery will benefit the patient. Therefore if the clinical signs of IVDD have persisted for over 48 hours, and the animal is a grade 5 for a prolonged amount of time, electroacupuncture is the treatment that shows the most benefit to these patients. In addition, if the client is unable to afford surgery, TCVM may be the only potentially effective treatment option.²

References

1.  Huisheng Xie. Chinese Veterinary Herbal Handbook. 2nd edition. Chi Institute of Chinese Medicine. 2008: page 6.

2.  Joaquim JG, et al. Comparison of decompression surgery. Electroacupuncture, and decompressive surgery followed by electroacupuncture for the treatment of dogs with intervertebral disc disease with long-standing neurologic deficits. J Am Vet Med Assoc. 2010;236:1225–1229.

3.  Hayashi AM, Matera JM, Fonseca Pinto AC. Evaluation of electroacupuncture treatment for thoracolumbar intervertebral disc disease in dogs. J Am Vet Med Assoc. 2007;231:913–918.

4.  Hayashi AM, Matera JM, da Silva TS, Pinto AC, Cortopassi SR. Electroacupuncture and Chinese herbs for treatment of cervical intervertebral disc disease in a dog. J Vet Sci. 2007;8:95–98.

5.  Janssens LA, Rogers PA. Acupuncture versus surgery in canine thoracolumbar disc disease. Vet Rec. 1989;124:283.

6.  Janssens LA. Acupuncture for the treatment of thoracolumbar and cervical disc disease in the dog. Probl Vet Med. 1992;4:107–116.

7.  Lai A, Chow DH, Siu WS, Holmes AD, et al. Effects of electroacupuncture on a degenerated intervertebral disc using an in vivo rat-tail model. Proc Inst Mech Eng [H]. 2008;222:241–248.

8.  Lubbe AM. Auriculotherapy in canine thoracolumbar disc disease. J S Afr Vet Assoc. 1990;61:187.

9.  Björn M. Cervical and thoracolumbar disc disease: diagnosis and treatment. In: Proceedings of 30th World Congress of the World Small Animal Veterinary Association (WSAVA), May 11–14, 2005, Mexico City, Mexico.

10.  Laitinen OM, Puerto DA. Surgical decompression in dogs with thoracolumbar intervertebral disc disease and loss of deep pain perception: a retrospective study of 46 cases. Acta Vet Scand. 2005;46(2):79–85.

11.  Millis D, Levine D. Canine Rehabilitation and Physical Therapy. 2nd edition. Saunders; 2014. VitalBook file.

12.  La JL, Jalali S, Shami SA. Morphological studies on crushed sciatic nerve of rabbits with electroacupuncture or diclofenac sodium treatment. Am J Chinese Med. 2005;33(4):663–9.

13.  Choi DC, Lee JY, Moon YJ, et al. Acupuncture-mediated inhibition of inflammation facilitates significant functional recovery after spinal cord injury. Neurobiol Dis. 2010;39(3):272–282.

14.  Zhang YM, Zhang YQ, Cheng SB, Chen SX, Chen AL, Tang CZ. Effect of acupuncture on proliferation and differentiation of neural stem cells in brain tissues of rats with traumatic brain injury. Chinese J Integr Med. 2013;19(2):132–6.

15.  Zhou HJ, Tang T, Zhong JH, et al. Electroacupuncture improves recovery after hemorrhagic brain injury by inducing the expression of angiopoietin-1 and -2 in rats. BMC Complement Altern Med. 2014;14(1):127.